[Biliary calculosis--new possibilities of treatment]

Abstract

The gallstone prevalence rate in Croatia is in the range of 10 to 20 per cent and for the population above age 65 years is around 30 per cent. Human gallstones are classified into two categories, i.e. cholesterol stones and pigment stones. Cholesterol stones account for 70-80% of gallstones. They are formed due to the bile supersaturation with cholesterol and later nucleation of cholesterol vesicles and crystal formation. Pigment stones of black type account for 20-25% of gallstones. They are formed as a result of chronic hemolysis. Surgery is still a method of choice in treatment of majority of patients with gallstones. It is a low-risk therapy with high success rate that can be used regardless the size, number, composition and localisation of gallstones. Cholesterol stones can be dissolved by direct instillation of methyl tert-butyl ether (MTBE therapy), fragmented by extracorporeal shockwaves (ESWL) and dissolved using bile salts chenodeoxycholic acid and ursodeoxycholic acid. The problems with these treatment modalities is high recurrence rate and limitation described for each method. Choledocholithiasis can be treated surgically, by endoscopic sphincterotomy combined with stone extraction and by extraction via T-tract. The decision on the best treatment modality in gallstone patients should be made only after careful evaluation of all relevant facts (type of stone, number and size of stones, localisation of stones, patient's age and general condition) taking into consideration the team experience. It is imperative not to use the treatment method with possible complication that cannot be dealt with in the institution performing the treatment.